Pilocarpine ophthalmic reduces the pressure in the eye by increasing the amount of fluid that drains from the eye. Pilocarpine ophthalmic also causes the pupil to become smaller and reduces its response to light or dark conditions.

Pilocarpine ophthalmic is used to treat glaucoma by lowering the pressure inside the eye. It is also used to lower the pressure in the eye in other circumstances when increased pressure might occur, such as before or after surgery.

Since pilocarpine ophthalmic makes pupils smaller, it is also used to reverse the effects of drugs that cause the pupils to become very large.

Pilocarpine ophthalmic may also be used for purposes other than those listed in this medication guide.

Use pilocarpine ophthalmic eyedrops or gel exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, pharmacist, or nurse to explain them to you.

Wash your hands before using your eyedrops or gel.

To apply the eyedrops:

• Tilt your head back slightly and pull down on your lower eyelid. Position the dropper above your eye. Look up and away from the dropper. Squeeze out a drop and close your eye. Apply gentle pressure to the inside corner of your eye (near your nose) for about 1 minute to prevent the liquid from draining down your tear duct. If you are using drops in both eyes, repeat the process. If you are using more than one drop in the same eye, repeat the process with about 5 minutes between drops.

To apply the gel:

• Tilt your head back slightly and pull down gently on your lower eyelid. Apply a thin film, about an inch long, into your lower eyelid. Close your eye and roll your eyeball around in all directions for 1 to 2 minutes. If you are also using eyedrops, apply them at least 5 full minutes before using the gel.

Do not touch the dropper or tube opening to any surface, including your eyes or hands. The dropper or tube opening is sterile. If it becomes contaminated, it could cause an infection in your eye.

Do not use any eyedrop that is discolored or has particles in it.

Store pilocarpine ophthalmic at room temperature away from moisture and heat. Keep the bottle or tube properly capped. Discard any unused medication on the expiration date.

Before using this medication, tell your doctor if you are using another eye medication, especially if it is a nonsteroidal anti-inflammatory drug (NSAID) such as flurbiprofen (Ocufen), suprofen (Profenal), diclofenac (Voltaren), or ketorolac (Acular).

Drugs other than those listed here may also interact with pilocarpine ophthalmic. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Use caution when driving, operating machinery, or performing other hazardous activities at night or in poor light. Pilocarpine ophthalmic may cause decreased vision in poor light. If you experience decreased vision, avoid these activities.

Do not touch the dropper or tube opening to any surface, including your eyes or hands. The dropper or tube opening is sterile. If it becomes contaminated, it could cause an infection in your eye.

The pilocarpine ophthalmic eyedrops contain a preservative (benzalkonium chloride), so do not wear soft contact lenses when applying this medication. Contact lenses can be inserted 15 minutes after you have applied the drops.

Avoid other eye medications unless your doctor approves.

Flush the eye with water and seek emergency medical attention.

Symptoms of a pilocarpine ophthalmic overdose include sweating, nausea, vomiting, diarrhea, watering mouth, and tearing eyes.

Apply the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and apply the next one as directed. Do not use a double dose of this medication.

Do not touch the dropper or tube opening to any surface, including your eyes or hands. The dropper or tube opening is sterile. If it becomes contaminated, it could cause an infection in your eye.

Apply light pressure to the inside corner of your eye (near your nose) after each drop to prevent the fluid from draining down your tear duct.

Use caution when driving, operating machinery, or performing other hazardous activities at night or in poor light. Pilocarpine ophthalmic may cause decreased vision in poor light. If you experience decreased vision, avoid these activities.

Rarely, pilocarpine ophthalmic may cause retinal detachment. Tell your doctor if you have any type of retinal disease, if you have had a retinal tear, if you are nearsighted, or if you have had cataract surgery. These conditions may increase the risk of retinal detachment.

Before using this medication, tell your doctor if you

• have heart failure,

• have high or low blood pressure,

• have ever had a heart attack,

• have asthma,

• have a stomach ulcer or stomach spasms,

• have epilepsy,

• have hyperthyroidism (an overactive thyroid),

• have blockage of your urinary tract or difficulty urinating, or

• have Parkinson’s disease.

You may not be able to use pilocarpine ophthalmic, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Pilocarpine ophthalmic is in the FDA pregnancy category C. This means that it is not known whether pilocarpine ophthalmic will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant.

It is not known whether pilocarpine passes into breast milk. Do not use pilocarpine ophthalmic without first talking to your doctor if you are breast-feeding a baby.

Your pharmacist has additional information about pilocarpine ophthalmic written for health professionals that you may read.

Pilocarpine ophthalmic is available with a prescription generically and under many different brand names. Solutions are available in strengths from 0.25% to 10%. A 4% gel is also available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.